Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 https://doi.org/10.1186/s13002-018-0217-8

RESEARCH Open Access Traditional knowledge on herbal drinks among indigenous communities in Azad Jammu and Kashmir, Pakistan Neelam Rashid1,3, Rodrigue Castro Gbedomon2*, Mushtaq Ahmad3, Valère Kolawolé Salako2, Muhammad Zafar3 and Khafsa Malik3

Abstract Background: Traditional knowledge about the use of medicinal plants for herbal drinks (HDs) is not well documented in the Azad Kashmir region despite their widespread use. This study highlights the taxonomic diversity and traditional knowledge on medicinal plants used for HDs while examining the diversity of diseases treated with HDs in the study area. Methods: Individual discussions were conducted with 255 informants (84 women and 171 men). Data gathered included (i) informant age and gender, (ii) HD species and respective plant parts used, (iii) health disorders treated, and (iv) mode of preparation and utilizations. Quantitative ethnobotanical indices including relative frequency of citation (RFC), informant consensus factor (ICF), and use value (UV) were used for data analyses. Results: Altogether, 73 medicinal plants belonging to 40 families and 66 genera were reported to be used in HD preparations, with Asteraceae being the richest family. The average number of HD species cited was 9.09 ± 0.17 per informant and did not vary either by age or gender. In addition, men and women, and adults and the young used the same pool of species (dissimilarity nearly zero). The most used plant parts were leaves (20.00%), roots (17.25%), and fruits (16.47%). Based on UV, the top five most used species were Valeriana jatamansi, Isodon rugosus, Onopordum acanthium, Acacia nilotica, and Viola canescens; and the UV was similar among gender and age categories too. The most utilized herbal preparation forms included decoctions, infusions, and tea. One hundred and eleven diseases grouped into 13 ailment categories were reported to be cured using HDs. The main category of disease treated with HDs was gastrointestinal (GIT) disorders (RFC = 17.43%). Relatively few species were used by a large proportion of informants for each category of ailment (ICF ≥ 0.60). Only one species was used for “glandular disorders” and “eye diseases” (ICF = 1). A novelty of about 22% (16 species) was recorded for HD species in the present work. Conclusion: The diversity of medicinal plant species used as HDs and the associated traditional knowledge are of considerable value to the indigenous communities of the Azad Kashmir region. Therefore, there is a need for conservation and preservation of medicinal HD species as well as the wealth of indigenous knowledge. The conservation effort should be high for species in the ailments categories glandular disorders and eye diseases. The therapeutic uses of HDs have provided basic data for further research focused on phytochemical and pharmacological studies and conservation of the most important species.

* Correspondence: [email protected] 2Laboratoire de Biomathématiques et d’Estimations Forestières, Faculty of Agronomic Sciences, University of Abomey-Calavi, 04BP 1525 Cotonou, Benin Full list of author information is available at the end of the article

© The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 2 of 20

Background the conservation issue, the excessive use of medicinal Traditional medicine (TM), also known as complemen- plants may lead to the misidentification of adulterant tary and alternative medicine in developed countries, is plants, hence compromising the quality control and widely used and is of rapidly growing interest in health standardization [25]. Moreover, ethnobotanical medi- care systems all over the world. About 80% of the cine in Pakistan is still a huge field of investigation. The world’s population, particularly in developing regions, last review on medicinal plants in Pakistan [25]evi- relies on TM practices to meet their health care needs denced the gaps of knowledge on herbal medicine and [1, 2]. TM is very popular and attracts much attention called upon extensive research. This paper aims at con- from a large spectrum of health system stakeholders, not tributing to this ongoing body of knowledge in herbal only for its accessibility and affordability for poor people medicinal, focusing on HDs. but also because of the risk of adverse effects of chem- HDs refer to beverages made from the infusion or de- ical drugs in allopathic medicine. As a recognition of its coction of herbals, spices, fruits, or other plant mate- importance and as a response to skepticism and disbelief rials, served cold or hot. They include herbal teas, fruit from some stakeholders, in 2002, the World Health drinks,infusions,anddecoctions.HDsarehighlyap- Organization defined a strategy to address issues of pol- preciated mostly because of their therapeutic purposes icy, safety, efficacy, quality, access, and rational use of [26]. In Pakistan, the available literature on medicinal TM [3]. TM includes medication therapies and non- plants used for HDs is recent and preliminary [2, 27], medication therapies. Whereas the latter are carried out and important issues remain unanswered and insuffi- primarily without the use of medication, the first involve ciently documented. Using the region of Azad Jammu the use of herbal medicines [4–6], animal parts [7–10], and Kashmir in Pakistan, this study aims at: and minerals [11, 12]. Among the medication therapies, herbal medicine or 1. Assessing the taxonomic diversity of plants used for phytotherapy is encountered worldwide, and its use is HDs. The medicinal plant richness of Pakistan is very ancient. Human use of plants as medicines was estimated to be about 600 to 700 plant species [25]. dated to at least the Middle Paleolithic age some What is the taxonomic composition of the pool 60,000 years ago [13, 14]. The Himalayan region com- selected for HD preparation? Based on the non- prised of Afghanistan, Bangladesh, Bhutan, China, random selection theory [28, 29], which predicts Myanmar, Nepal, Pakistan, and India is reputed to be a that medicinal plant selection is not random, it is rich storehouse and hotspot of valuable medicine plant expected that the number of medicinal plant species. About 1748 plant species corresponding to species used for HDs differs across botanical 21.85% of the local 8000 angiosperm species are used for families. medicinal purposes [15]. 2. Assessing the traditional knowledge on HDs and its In Pakistan, the flora is quite rich and is estimated to relationship with age and gender. Indeed, the use of consist of about 6000 species of higher plants of which medicinalplantsisbasedontrialanderrorandis 600 to 700 species, the majority growing in the wild, are passed on from one generation to another, after used for medicinal purposes [16]. Throughout the coun- refinement and additions [30]. What is the try, TM using plant species is popularly practiced among traditional knowledge (species uses, plant parts a large segment of its population [17–20]. Eighty percent used, mode of preparation, etc.) related to HD of people belonging to the rural areas still depend upon preparation? Because various individual socio- the herbal medicines in Pakistan. The most realistic and cultural and demographic traits, mainly gender and commonly employed therapy for diseases is to make in- age, are correlated with an individual’s level of plant fusions or decoctions from different plant parts [21]. knowledge [31–33], we expected traditional know- Local market systems named “Pansara” specifically dealing ledge related to HDs to be associated with age and with medicinal business have been reported [16, 22–24], gender. With women and older people tending to with important quantities of plants exchanged locally or have a greater knowledge of local medicinal flora exported. For some years, important concerns due to ex- [31, 34], we hypothesized that traditional know- cessive use of herbal medicine have arisen and are related ledge on HDs is mostly held by women and old to the conservation issue of medicinal plant species [16] people in Pakistan. and adulteration of botanical medicine [24]. Indeed, the 3. Assessing the diversity of diseases treated by HDs. majority of medicinal plants used for the herbal drug in- About 10–12% of plants in Pakistan are used to dustry and local communities come from wild collection. meet health care needs. In the special case of HDs Overexploitation and unsuitable collection methods are made of medicinal plants, what diseases are treated, contributing to the extinction of some medicinal plants and which plants are solicited? We expected some and bringing others to the brink of extinction [16]. Beyond diseases to be treated by a restricted set of plants. Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 3 of 20

Methods Ethnographic and socio-economic characteristics of the Study area Azad Jammu and Kashmir region The region of Azad Kashmir is positioned between Overall in the Azad Jammu and Kashmir region, 34°22′ North latitude and 73°28′00 East longitude. Mughals, Syed, Raja, Chaudhary, and Maliks are the The total area is about 13,297 km2 [35]. The study prominent castes. Azad Kashmir is generally considered sites included eight districts; Muzaffarabad, Mirpur, as a Pahari speaking region. There is a large Gojri Kotli, Bagh, Poonch, Palandari, Neelum, and Bhimber. community and some pockets of Kashmiri, especially in The region of Azad Jammu and Kashmir is character- Neelam Valley regions. Hindu and Punjabi are also ized by a craggy landscape, mountains, waterfalls, spoken in Muzaffarabad and Bhimber areas, respectively, paddocks,river,streams,plains,andforests[36] adding to the cultural diversity of this region. Urdu (Fig. 1). enjoys the status of official language in the region. The region of Azad Jammu and Kashmir has varied Kashur, the language of Kashmir, is spoken by families climatic characteristics with temperate, humid, sub- residing in different parts of Azad Kashmir [38]. The tropical, and sub-alpine eco-regions. Due to peculiar population of the valley is approximately over 4 million. geographical and climatic conditions, this area is gifted The population density in Azad Kashmir is estimated at with a rich floral diversity [37]. The local inhabitants of 343.5 inhabitant/km2. Azad Jammu and Kashmir belong to various cultures Internally, the region of Azad Jammu and Kashmir is and speak different local or native languages such as organized into three administrative divisions including Pahari, Pothohari, Hindko, and Gojri, and the Urdu Mirpur, Poonch, and Muzaffarabad. The divisions are language is also well-known to the local people. further divided into 10 districts and 30 sub-districts or

Fig. 1 Map of Azad Jammu and Kashmir Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 4 of 20

Tehsils. Most of the Kashmiris live in villages and are Herbarium of Pakistan (http://herbarium.qau.edu.pk/)in dependent on agriculture. Local people are primarily af- Islamabad for formal identification and authentication. filiated with agriculture and also rear livestock. The plain areas of this region have an agricultural economy pri- Concept clarification marily dependent on rainfall. Maize, wheat, and rice are Herbal medicine, also known as herbalism or botanical the main crops, and beans and peas are also cultivated medicine, is a medical system based on the use of plants in the area. Tourism has greatly improved the socio- or plant extracts to treat illness and to assist bodily func- economic conditions of the area by providing job oppor- tions. Sometimes, herbal remedies are prepared as drinks tunities to local people. Local people work in hotels and by following different techniques and are served hot or restaurants, as guides and jeep drivers, and some have cold. They include herbal teas, fruit drinks, infusions, and opened shops at tourist resorts. decoctions prepared for medicinal purposes. This defin- ition excludes “recreational tea” [26] and other beverages prepared as an infusion or decoction that are consumed Sampling and data collection primarily in a food fortification context or for their general Sampling socio-cultural and recreational value. There are different The sampling method combined both probabilistic and modes of preparation/utilizations of HDs (Table 1). non-probabilistic approaches. First, 5 villages were pur- posely chosen in each one of the 8 districts of the study Ethical consideration area, for a total of 40 villages. The main criterion of se- The data were collected with critical care by keeping in lection was the prevalence of herbal medicine practice. view the cultural values of local communities. Respondents Second, for each district, a sub-sample size of about 30 were informed that the study was carried out for academic to 35 informants was chosen, for a total of 255 infor- reasons and not for commercial purposes. Finally, infor- mants for the whole study area. A sample size of a mini- mants acknowledged the concept and reached an mum of 30 informants per district is the minimum size agreement. Prior, informed consent was obtained for con- for a good approximation of the normal distribution [39] ducting interviews, and the researchers involved in the and for sound statistical analyses. Before entering each conceptualization of this study adhered to the ethical of the study areas, permission was sought from a local guidelines of the International Society of Ethnobiology [42]. area leader after explaining the objectives of the study. From this leader, we took the name of the first key in- Statistical analyses formant, whereas the rest of the respondents were se- Quantitative ethnobotanical indices including relative lected by a snowball sampling technique [40]. Out of the frequency of citation (RFC), informant consensus factor 255 interviewed persons, 76 % were male, and the (ICF), and use value (UV) were used for data analyses. remaining 24% were female. Thirty percent of infor- mants were under 40 years old. Taxonomic diversity of plants used in HDs by communities in Azad Jammu and Kashmir Data collection The taxonomic plant diversity was assessed through the The collection of data was undertaken by an experienced calculation of the species richness, genera richness, and researcher who had a strong knowledge of the local languages and culture of Azad Jammu and Kashmir. Table 1 Definition of some concepts related to herbal drinks Ethnobotanical data were collected during individual Herbal drinks Definition interviews and group discussions with informants. Ques- Herbal tea (HT) An herbal beverage made with flowers, leaves, and tions asked during the interviews were related to socio- soft stems of plants. Herbal tea is light combining both recreational and medicinal purposes. demographic characteristics of informants (name, age, gender, occupation, area, etc.) and plant information Herbal An herbal tea made from longer steeping or boiling infusion (HI) with a larger amount of herb. Herbal infusion is (local name of species, habitat, part used, disease treated, exclusively used for medicinal purpose and to mode of preparation and utilization, dose of application, provide body with high dose of vitamins and duration of treatment, status of the species, etc.). Inter- minerals. Infusion is intended to extract vitamins and volatile ingredients from the leaves and flowers. views were conducted in the local language and lasted on average 15 to 30 min depending on interview Herbal An herbal beverage made with roots, barks, seeds, decoction rhizomes, and woods and intended to extract mineral conditions. (HD) salts and bitter principles from plants. Unlike The specimens of the plants used in HDs were col- infusions, decoctions are left on the heat and lected and preserved using herbarium techniques as sug- simmered for a length of time. gested by [41]. Vouchers were first identified using the Herbal fruit An herbal beverage made with fruits. juice (HFJ) Flora of Pakistan and were sent to the National Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 5 of 20

family richness. The RFC of species, expressed as the ra- calculated. Here, ICF estimates the relationship between tio (in %) between the numbers of informants who cited the “number of use-reports in each category (nur) minus the species divided by the total number of surveyed in- the number of species used (nt)” and the “number of use- formants, was used to identify the most frequently cited reports in each category minus 1,” as described in Eq. 1. species. n −n ICF ¼ ur t ð1Þ n −1 Local traditional knowledge on HDs in Azad Jammu and ur Kashmir Values of ICF range from 0 to 1. A high value (close to 1) indicates that relatively few taxa (usually species) Gender and age differences in the knowledge of HD are used by a large proportion of people, whereas a low species The species used for HDs were compared be- value indicates that the informants disagree on the taxa tween men and women and between informants aged to be used in the treatment within a category of illness. less than 40 years and informants aged 40 years and older using both quantitative and qualitative aspects. UV of HD plant species and relationship with gender The rationale for this analysis was that number of spe- and age category of informants The importance of cies used may be similar, whereas the species used could each single species in HDs was estimated using the rela- be quite different. A Poisson generalized linear model tive UV [45], which is a modified version of the UV (GLM) was used to assess the relationship between the method introduced by Phillips and Gentry [46]. This number of species cited on one hand, and gender and modified version of UV (Eq. 2) captures all the known age category and their interaction on the other. Analysis uses by an individual: of similarities (ANOSIM) [43] was used to test whether Xn there was a significant difference between men and UR UV ¼ i ð2Þ women or informants aged less than 40 years and those i¼1 n aged 40 years and older with respect to species used. ANOSIM provides a way to test whether there is a sig- URi is the number of use-reports mentioned by in- nificant difference between two or more groups of sam- formant i. n is the number of informants. pling units. ANOSIM operates directly on a dissimilarity UV was used to identify the top 14 species in HDs, matrix and is philosophically allied with non-metric i.e., species with the highest values of UV. The data multidimensional scaling ordination [44] in that it uses showed that for all top 14 species, each informant men- only the rank order of dissimilarity values. If two groups tioned either one or no use of each single species (i.e., of sampling units are really different in their species no informant mentioned more than one use for each composition, then compositional dissimilarities between single species). Therefore, a binomial logistic model was the groups ought to be greater than those within the used to assess whether the UV of each of the top 14 spe- groups. The ANOSIM statistic R is based on the differ- cies was related to gender and age category. The full ence of mean ranks between groups. It ranges from 0 to model was first specified, and then a stepwise selection 1, 0 indicating a completely random grouping and 1 in- method based on AIC (Akaike information criterion) dicating a completely different species composition. was used to select the parsimonious model. All statistical analyses were implemented in R software Plant parts used for HDs First, a list of plant parts used [47], and the significance level was considered at alpha for HDs was established. Next, the RFC of each plant = 0.05. part expressed as the proportion of informants who mentioned that plant part was computed as a measure Results of informant consensus on its use in an HD. Taxonomic diversity and life form of plants used in HDs in Azad Jammu and Kashmir Preparation and mode of utilization The diversity of Seventy-three species belonging to 40 families and 39 the preparation mode of HDs and its occurrence among genera were cited as being used for HDs. The richest informants was calculated using RFC. The utilization family was Asteraceae (9 species) followed by Lamiaceae mode reported by informants was then described. (7 species) and Fabaceae (5 species). Twenty-eight fam- ilies had only one species, whereas seven families had Medicinal uses of HDs in Azad Jammu and Kashmir only two species (Fig. 2). The most common genera re- ported were Solanum, Morus, and Mentha. Informant consensus on medicinal uses of HDs To The 73 reported plant species were dominantly herbs determine informant consensus on the spectrum of spe- (69.86%). The remaining were comprised of shrubs cies used for each category of ailment, the ICF was (16.43%), trees (12.35%), and climbers (1.36%). Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 6 of 20

Fig. 3 a Diversity of plant species used in herbal drinks across gender. b Diversity of plant species used in herbal drinks across age categories

of cited species was 9.08 ± 0.21 for informants aged less than 40 years and 9.12 ± 0.29 for informants aged 40 years and older (Fig. 3b). From a qualitative perspective, the ANOSIM R statis- tic was − 0.0045 (prob. = 0.613) and 0.0083 (prob. = 0.225), respectively, for age and gender, indicating that both men and women or adults and the young used the same pool of species for HDs as illustrated by the quasi overlapping of the confidence ellipses (see Fig. 4).

Plant parts used in HD preparation Overall, several parts of the plant were used in HDs, in- cluding leaves, roots, stems, fruit, seeds, rhizomes, and bark. Leaves was the most cited plant part (20.00%) followed by roots (17.25%) and fruits (16.47%). Seeds and rhizomes were the least cited plant parts and grouped in the category “others.”

Preparation and modes of utilization of HDs Fig. 2 Family rank of species used in herbal drinks in Azad Jammu Generally, HDs are prepared using simple methods de- and Kashmir pending on the plant material. The utilization modes in- cluded tea, juice, infusion, decoction, and beverage. The main form of utilization reported by informants was de- Local traditional knowledge on HDs in Azad Jammu and coction. Decoctions are easier to make because plant Kashmir parts are only to be boiled with water. Mostly, fresh Gender and age differences in the knowledge of HD species plant parts are preferably used in preparation of HDs as Quantitatively, the number of cited species per informant reported by informants, and dried parts are also used. varied from 1 to a maximum of 17. The number of re- Informants reported that drying the plant parts may re- ported species did not differ either between gender (df = 1, duce the effectiveness of bio agents, because the ingredi- deviance = 0.78, prob. = 0.376) or between age categories ents present are damaged to some extent. Almost all (df = 1, deviance = 0.042, prob. = 0.837). Although not sig- preparations reported in the study (Table 2) were made nificant, men cited on average more species (9.23 ± 0.21) from a single plant species with addition of sugar, water, than women (8.82 ± 0.32) (Fig. 3a). The average number and in some cases honey to increase the taste. Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 7 of 20

Fig. 4 a Similarity of plant species used in herbal drinks across gender. b Similarity of plant species used in herbal drinks across age categories

UV of HD plant species HD plant diversity and life forms The UV of species varied from 0.0039 to 0.2196. The first Most of the people inherited traditional knowledge 14 species with the highest values of UV are summarized from their elders and continued to transmit it from in Table 3,withV. jatamansi, I. rugosus, O. acanthium, A. one generation to another [48]. Female informants nilotica,andV. canescens being the top 5 most used spe- were less numerous in the present study, owing to cies. The results of the models run to test how their UV the reason that they were reluctant to give informa- varied across gender and age categories are summarized tion, and used plants in homes and at a domestic in Table 3 too. For all the species (except V. jatamansi), level only. Among the reported plant families, Astera- UV differed insignificantly (p value > 0.05) between men ceae was the most used in the treatment of various and women and between age categories. UV of V. diseases. The reason for dominance of this family in jatamansi was lower for men (est = − 0.88, se = 0.38, prob. plantsusedforHDsmaybethattheplantsbelonging =0.021). to this family are naturally diverse and widespread in the study area [49, 50]. Asteraceae is also the largest Medicinal uses of HDs in Azad Jammu and Kashmir plant family in the world including over 1600 genera One hundred and eleven (111) diseases grouped into 13 and 23,000 individual species, many of which are im- ailment categories were reported to be cured using HDs portant for medicinal uses. This pattern is consistent (Table 4). The most frequently cited diseases were with the non-random plant selection theory, which gastrointestinal (GIT) diseases, respiratory diseases, and predicts that the number of medicinal species used in fevers. The least cited diseases were urinary disorders, a botanical family in a given region would be linearly oral diseases, and infectious diseases (Table 4). related to the total number of plant species in that For all 10 ailment categories, values of IFC were all family [51, 52]. Therefore, these plants are easily greater than 0.60 (Fig. 5) indicating that relatively few available and are consumed locally for various pur- species were used by a large proportion of informants poses, particularly medicinal uses. Family Asteraceae for each category of ailment. In paricular, only one spe- was also reported elsewhere to be the largest plant cies, Quercus oblonga, was used for “glandular disor- family in terms of the number of medicinal plants ders,” and only one other, Tagetes minuta, was used for used in the treatment of various ailments [53, 54]. “eye diseases” (Fig. 5). Such a similarity may be due to the presence of bio- logically active chemical constituents that make them Discussion medicinally important [55]. This study conducted within the indigenous communi- Herbs were exploited preferably than shrubs and trees ties of the region of Azad Jammu and Kashmir, Pakistan because of their availability in addition to their high ef- (i) assessed the diversity and life forms of plants used in fectiveness for treatment of diseases than other growth HDs and tested for generation and gender differences in forms. The frequent utilization of herbaceous medicinal terms of known HD plant species; (ii) identified the most plants was also described in studies conducted in various commonly used plants for HDs and the species-specific regions of the world [27, 56–59]. The reason for exten- uses relationship with gender and generation; (iii) docu- sive utilization of herbs may be due to their easy accessi- mented plant parts used in HD preparations, preparation bility as well as their therapeutic properties [60–62], as mode, and mode of utilization; and (iv) determined the supported by the availability hypothesis, which predicts diseases treated by HDs and the diversity of plants used that plants are used for medicine because they are more for each disease. accessible or locally abundant [63, 64]. Rashid Table 2 Ethnomedicinal uses of herbal drinks in Azad Kashmir Scientific Voucher no in Local name Life Plant part Administration Disease Preparation mode Active constituents UV RFC name Pakistan NH form used treated†† [literature reference] Ethnomedicine and Ethnobiology of Journal al. et Acacia nilotica (L.) ISL −49,177 Keekar Tree Bark Decoction Toothache Bark is ground to powder and put into Alkaloids, saponins, 0.03 0.09 Willd. ex boiling water. Decoction prepared is used anthraquinones Delile Fabaceae for gargling in case of toothache. [102] Achillea ISL-40550 Rattiboti Herb Leaves, Decoction, Brain disorders, Boiling water is poured over dried leaves, Tannins, flavonoids, 0.16 0.27 millefolium L. flower fever, piles, and this hot infusion is taken to induce saponins [103] Asteraceae infusion, headache, sweating that relieves fever. Tea is made tea stomach by dissolving plant material in boiled disorders water and sugar can also be added. Tea is consumed in case of stomach disorders. †Adiantum ISL-100609 Kakwa Herb Leaves, Infusion Fever Infusion of leaves is prepared by pouring Flavonoids, 0.08 0.14 venustum D. roots hot water over leaves of plant. Sugar can terpenoids, Don Pteridaceae also be added. This infusion is taken twice steroids [104] a day to relieve fever. Aerva javanica ISL-50064 Boikalan Herb Leaves Infusion Stomach Leaves are infused in hot water which is Terpenoids, 0.01 0.12 (Burm.f.) Juss. disorders then consumed to get ease from stomach alkaloids [105] (2018)14:16 ex Schult. disorders. Amaranthaceae Ajuga integrifolia ISL-109327 Kauri booti Herb Leaves, Decoction Jaundice 1–2 g of dried leaves is boiled in water. Glycosides, 0.01 0.09 Buch.-Ham. stem The decoction prepared is taken in early terpenoids [106] ex D.Don Lamiaceae morning before breakfast to treat jaundice. Amaranthus viridis ISL-115671 Ganhar Herb Leaves Decoction Anemia Leaves of plant are boiled in water for 1 h Tannins, 0.03 0.13 L. Amaranthaceae to make decoction at slow heat. Half cup flavonoids, of decoction is then taken once a day in glycosides [107] case of anemia. Arnebia benthamii ISL-94123 Ghaozban Herb Root Tea Pneumonia, Tea is prepared from roots of plant and Phenolics, 0.05 0.09 (Wall. ex G.Don) flu taken three times a day in case of steroids [108] I.M.Johnst. pneumonia. Boraginaceae Bauhinia variegate ISL- 54078 Kachnar Tree Leaves, Infusion Inflammation Leaves and crushed flowers are soaked in Alkaloids, saponins, 0.03 0.15 L. Fabaceae flowers water for 2 days then filtered. Hot water is phenolics, tannins, poured over this filtrate which is used saponins [109] against inflammation. Berberis lycium ISL-108676 Sumbal Shrub Fruit, Infusion, juice, Cough, Grinded root bark mixed with water, Phenolic, 0.05 0.11 Royle. root decoction jaundice, and sugar is taken before sleeping in sore flavonoids [110] Berberidaceae Sore throat throat and pain Juice of fruit is used in gum troubles. Bergenia ciliata ISL 100171 Batwaya Herb Rhizome Infusion Earache, Rhizome is grinded and 1–2 teaspoon of Alkaloids, 0.1 0.14 (Haw.) Sternb. muscular powder is infused in boiling water which is flavovoids,

Saxifragaceae pain taken before breakfast for muscular pains. phenolics, 20 of 8 Page glyscosides saponins [111] Table 2 Ethnomedicinal uses of herbal drinks in Azad Kashmir (Continued) Rashid Scientific Voucher no in Local name Life Plant part Administration Disease Preparation mode Active constituents UV RFC name Pakistan NH form used treated†† [literature reference] Ethnomedicine and Ethnobiology of Journal al. et Cannabis sativa L. ISL-101521 Bhang Herb Leaves Beverage Mental Leaves and flowering tops are mixed with milk Terpenes, 0.02 0.08 Cannabaceae relief with addition of sugars and almonds to make flavonoids [112] drink sardai which helps in mental relaxation. Carissa spinarum L. ISL-22557 Granda Shrub Leaves Infusion Jaundice Infusion of leaves is taken orally in Flavonoids [113] 0.04 0.05 Apocynaceae early morning to treat jaundice. Chrysojasminum ISL-116143 Chambeli Shrub Root Decoction Ringworm Roots are boiled in Glucoside, 0.07 0.2 humile (L.) Banfi water. Decoction obtained is phenolics [114] Oleaceae cooled for 10–15 min and then consumed orally in case of ringworm. Cichorium intybusl. ISL-116352 Handh Herb Flowers, Decoction Bronchial 2–3 g of flowers and leave’s material is Alkaloids, 0.02 0.08 Asteraceae leaves, root disorders boiled in water and given orally at least flavonoids, once in a day to get ease in respiratory saponins [115] disorders. (2018)14:16 Corydalis incisa ISL-116140 Papra Herb Whole Decoction, Fever, Ground plant material is taken, Tannins, 0.06 0.07 (Thunb.) Pers. plant juice blood and water is added in it. The juice is then alkaloids [116] Papaveraceae purifier extracted which is used to relieve fever. Cymbopogon ISL 48939 Serai Shrub Leaves Tea Stomach Leaves are infused in hot water for Alkaloids, 0.13 0.09 citratus (DC.) disorders, 20 min to make tea which is given saponins, Stapf Poaceae headache to treat stomach pain. tannins [117] Cynoglossum ISL-196130 Lainda Herb Root Decoction Joint Decoction of root is taken for Alkaloids, 0.04 0.16 lanceolatum pain rheumatic flavonoids, Forssk. disorders. triterpenes [118] Boraginaceae Diospyros lotus L. ISL-68699 Kala Amlook Tree Fruit Juice Stomach Juice of fruit is extracted and Tannins, 0.05 0.35 Ebenaceae disorders consumed in case of stomach problems. alkaloids [119] Ephedra gerardiana ISL-67687 Asmanipoda Herb Root Decoction Joint pain Roots decoction is taken twice a day Alkaloids, tannins, 0.03 0.23 Wall. ex Stapf to treat rheumatism. glycosides [120] Ephedraceae †Euphorbia illirica ISL-68688 Kankoli Shrub Leaves Infusion Urinary Leaves are infused in hot water and taken Alkaloids, 0.01 0.07 Lam. Euphorbiaceae disorders orally to help treat urinary problems. flavonoids [121] Euphorbia ISL-65674 Hazardaani Herb Stem Decoction Dysentery, Stem is chopped into pieces and boiled Tannins, 0.08 0.13 prostrata Aiton diarrhea in water then cooled for 1 h. glycosides [122] Euphorbiaceae Decoction is given orally after intervals to treat dehydration problems. †Fagonia cretica L. ISL 47236 Temaan Shrub Leaves Infusion Cough Infusion of leaves is taken to get relief Terpenoids, 0.02 0.07 Zygophyllaceae from cough with regular intervals of saponins [123]

hours. 20 of 9 Page † Fagopyrum ISL-116233 Hulla Herb Root Juice Fever Juice of root is taken in case of fever. Glucosides, 0.04 0.13 esculentum Moench tannins [124] Polygonaceae Table 2 Ethnomedicinal uses of herbal drinks in Azad Kashmir (Continued) Rashid Scientific Voucher no in Local name Life Plant part Administration Disease Preparation mode Active constituents UV RFC name Pakistan NH form used treated†† [literature reference] Ethnomedicine and Ethnobiology of Journal al. et Foeniculum vulgare ISL 103476 Sonf Herb Seeds Decoction, Stomach 10 g seeds boiled in 100 ml water and Glucoside, 0.09 0.17 Mill. infusion disorders, decoction prepared which is used to saponins, Apiaceae diarrhea cure stomachache and diarrhea. alkaloids [125] Fragariavesca L. ISL-106789 Budhamewa Herb Leaves, fruit Juice Menorrhagia Juice of leaves is extracted and taken Phenolics, 0.05 0.17 Rosaceae at least once in a day in case of Flavonoids [126] menstrual pain. Gentiana kurroo ISL-67293 Pashanbhed Herb Leaves, Decoction Blood tonic Decoction of leaves and flowers are Phenolics, 0.04 0.2 Royle. Gentianaceae flower used as a blood purifier. flavonoids and proanthocyanidins [127] Geranium ISL-101166 Ratanjote Herb Flower Tea Rheumatism Flowers are boiled with water Steroids, 0.03 0.09 wallichianum D. and mixture is stained. This tea coumarins [128] Don ex Sweet is taken in the morning for treating joint pain. Geraniaceae (2018)14:16 †Gerbera gossypina ISL- 96899 Ladrun Herb Root Juice Blood pressure, Root juice consumed to lower the Alkaloids, 0.08 0.11 Royle Asteraceae gastric blood pressure. flavonoids [129] diseases †Geum ISL-97938 Shoonkar Herb Root Decoction Dysentery, Decoction of root is consumed Sterols, 0.04 0.09 adnatum Wall. diarrhea orally in case of chronic dysentery terpenoids [130] Rosaceae or diarrheal bleeding. †Isodon rugosus ISL-16965 Peemar Shrub Leaves Juice Diarrhea Leaves juice is extracted with water Alkaloids, 0.04 0.05 (Wall. ex Benth.) and is given to treat diarrhea two glycosides, Codd times a day. flavonoids, Lamiaceae terpenoids, anthraquinones [131] Justicia adhatoda ISL 13237 Baikar Shrub Leaves Decoction Bronchial Decoction of leaves is taken to give Alkaloids, 0.03 0.07 L. Acanthaceae diseases ease in cough and bronchial disorders. tannins [132] †Laphangium affine ISL-40456 Janglidodal Herb Leaves Decoction Influenza 5 g of leaves are boiled in water. Flavonoids, 0.03 0.17 (D. Don) Tzvelev Decoction prepared is cooled and alkaloids, Asteraceae put into bottle. This is used from terpenes [133] time to time in case of flu and cold. †Leucas cephalotes ISL 16961 Chara Herb Leaves Decoction Malaria Decoction is prepared and consumed Sterols, 0.04 0.09 (Roth) Spreng. in case of malaria. flavonoids [134] Lamiaceae Malva neglecta ISL 66146 Sonchal Herb Leaves Decoction Constipation Leaves boiled in water are frequently Alkaloid, flavonoid, 0.02 0.12 Wall. Malvaceae consumed in case of constipation. saponin [135]

Mentha arvensis L. ISL 116029 Podina Herb Leaves Infusion Diarrhea, Dried leaves are infused in boiling Alkaloids, flavonoids, 0.06 0.07 20 of 10 Page Lamiaceae vomiting water and taken in case of diarrhea tannins, phenols, and vomiting. cardiac glycosides [136] Table 2 Ethnomedicinal uses of herbal drinks in Azad Kashmir (Continued) Rashid Scientific Voucher no in Local name Life Plant part Administration Disease Preparation mode Active constituents UV RFC name Pakistan NH form used treated†† [literature reference] Ethnomedicine and Ethnobiology of Journal al. et Mentha longifolia ISL 116056 Babri Herb Leaves, Tea Abdominal Leaves are dried and then boiled with Terpenoids, 0.07 0.21 (L.) Huds. Flower diseases, water to make tea which is used in flavonoids [137] Lamiaceae vomiting, vomiting. nausea Morus alba L. ISL-10625 Chitta toot Tree Bark Decoction Asthma Bark is chopped into pieces, boiled in Phenolics, flavonoids 0.03 0.09 Moraceae water and decoction is given to get relief [138] in severe cough. Morus nigra L. ISL-10697 Kala toot Tree Fruit Decoction Throat pain Fruit decoction is prepared and gargled Phenolics, 0.05 0.17 Moraceae in sore throat. flavonoids [138] †Muehlenbeckia ISL-97865 KhattaHulla Herb Leaves Juice Bleeding 10–15 g leaves are put in water for 2 h. Anthraquinones 0.03 0.11 hastulata (Sm.) Juice obtained is taken in case of internal [139] I.M. Johnst. bleeding. Polygonaceae Nerium oleander L. ISL-47361 Gandeera Herb Leaves Decoction Stomach Half kg branches boiled in 2 L of water Tannins, saponins, 0.1 0.15

Apocynaceae ailments, for 2 h in order to make decoction. terpenoids [140] (2018)14:16 constipation Two teaspoon of this decoction used daily for constipation and stomach pain. Ocimum basilicum L. ISL 16251 Neazbu Herb Whole Juice Stomach Juice of plant is consumed in case of Phenolics [141] 0.04 0.07 Lamiaceae plant diseases stomach disorders. Oenothera rosea L ISL 10057 Jungligulab. Herb Leaves, Infusion Constipation Plant material is infused in boiling water Carbohydrates, 0.04 0.15 Her. ex Aiton stem and taken in case of constipation. tannins, saponins, Onagraceae and steroids [142] Olea europaea ISL-116120 Kaahu Tree Leaves Decoction Toothache, Decoction of leaves is prepared and Flavonoids, 0.06 0.11 (Wall. and G.Don) infections used in gargling in toothache. tannins [143] Cif. Oleaceae †Onopordum ISL-98635 Kandyara Herb Leaves, Decoction,juice Ulcers Stem decoction is preferably consumed Terpenoids [144] 0.02 0.12 acanthium L. stem to treat stomach ulcers. Asteraceae Onosma bracteata ISL-95864 Gaozaban Herb Leaves Decoction Stomach Leaves infusion is consumed after regular Tannins, terpenoids, 0.04 0.09 Wall. Boraginaceae disorders intervals until get relief from stomachache. flavonoids [145] Oxalis corniculata L. ISL-38367 Khattibooti Herb Whole Infusion Stomach Whole plant powder is mixed in hot water Carbohydrates, 0.02 0.12 Oxalidaceae plant disorders with addition of sugar, stained, and given glycosides, for stomach ailments. phenols [146] Paeonia emodi ISL-91236 Mamaikh Herb Root Decoction Blood Roots are boiled in water and taken as a Flavonoids, sterols, 0.02 0.35 Royle purification remedy to purify blood. saponins [147] Paeoniaceae Periploca aphylla ISL-22591 Batta Shrub Bark Decoction Stomach Bark decoction is taken to give relief in Alkaloids, 0.02 0.13

Decne disorders stomach disorders. flovonoids, 20 of 11 Page Apocynaceae terpenoids [148] Persicaria alpine ISL-106743 Masloon Herb Seeds Infusion Diarrhea, Seeds are infused in water. The mixture is Terpenoids, 0.1 0.15 (All.) H.Gross fever stained and kept in a bottle. This mixture flavonoids [148] Polygonaceae is consumed daily in case of fever. Table 2 Ethnomedicinal uses of herbal drinks in Azad Kashmir (Continued) Rashid Scientific Voucher no in Local name Life Plant part Administration Disease Preparation mode Active constituents UV RFC name Pakistan NH form used treated†† [literature reference] Ethnomedicine and Ethnobiology of Journal al. et †Pimpinella ISL 103476 Tarpakhi Herb Leaves Decoction Cough, cold Leaves decoction is consumed in cough Phenols, 0.04 0.09 diversifoliaDC. and cold. glucosides [149] Apiaceae Punica granatum L. ISL 87324 Daroona Shrub Fruit Juice Stomach Seeds are soaked in water for a day then Alkaloids, flavonoids, 0.02 0.18 Punicaceae ailments filtered the mixture. Add sugar and taken tannins, saponins twice to treat stomach aches. [150] Quercus oblongata ISL-10672 Reen Tree Bark Decoction Rectal Decoction is made by using ground bark Tannins, terpenoids, 0.05 0.17 D.Don disorders powder and given for intestinal disorders. steroids, alkaloids [151] Fagaceae Rheum australe ISL-98765 Chutial Herb Root Decoction Acidity Roots are boiled in water and given Anthraquinones 0.02 0.09 D.Don orally to treat acidity. [152] Polygonaceae Rubus fruticosus ISL-106878 Aakhray Herb Leaves, Infusion, Dysentery, Leaves are boiled in water and Phenolics, 0.1 0.1 L. Rosaceae roots decoction diarrhea, consumed in case of cough. tannins [153]

bleedings, Decoction of flowers is also consumed (2018)14:16 whooping in dysentery. cough †Smilax aspera L. ISL-11624 Shogr Herb Whole Decoction Infection Decoction of whole plant is prepared Phenolics, 0.02 0.07 Smilacaceae plant and cooled. It is used to treat infection. flavonoids [154] Solanum nigrum L. ISL 112661 Kachmach Herb Leaves, Juice Rheumatism, The juice of the leaves can be used alone Alkaloids, 0.1 0.16 Solanaceae flower, cough, fever, or with addition of honey to cure diarrhea saponins, fruit bronchitis, and cough. tannins [155] diarrhea † Solanum ISL-67895 Mokri Herb Leaves, fruit Infusion Body pain Fruit peels are infused in water and Terpenes, 0.01 0.21 surrattense Burm. f. consumed for a week to get relief from phenolics, Solanaceae body pain. quinones [156] †Solanum ISL-10237 Ghanar Herb Leaves Infusion Skin Infusion of leaves is taken once in a day Alkaloids, 0.05 0.09 virginianum L. diseases for skin diseases. flavonoids [156] Solanaceae Sonchus asper (L.) ISL-10987 Dodhal Herb Leaves Infusion Abdominal Leaves infusion is taken in case of Steroids, 0.02 0.13 Hill Asteraceae diseases abdominal pain. glycosides, flavonoids [157] Swertia petiolata D. ISL-33193 Chirayetta Herb Leaves, Decoction Ulcers, asthma, Decoction of plant is given twice a day Terpenoids, 0.16 0.12 Don stem, root urinary in case of urinary disorders. flavonoids, Gentianaceae disorders alkaloids [158] Tagetes minuta L. ISL-16983 Satbarga, Herb Leaves, Juice Earache and Leaves and flowers juice is extracted with Saponin, tannin, 0.13 0.13 Asteraceae Gainda flower ophthalmic water and taken orally in case of earache. alkaloid [159]

Tamarindusindica L. ISL-10045 Imli Tree Fruit Infusion Fibril Peels of fruit are infused in water and Alkaloids, 0.04 0.17 20 of 12 Page Fabaceae diseases taken to treat fibril disorders. anthraquinone, glycoside [160] Table 2 Ethnomedicinal uses of herbal drinks in Azad Kashmir (Continued) Rashid Scientific Voucher no in Local name Life Plant part Administration Disease Preparation mode Active constituents UV RFC name Pakistan NH form used treated†† [literature reference] Ethnomedicine and Ethnobiology of Journal al. et Taraxacum officinale ISL-116231 Peelibooti Herb Leaves Decoction Constipation, Leaves are boiled in water and consumed Glucosides, 0.04 0.13 F.H.Wigg. jaundice to treat constipation. terpenoids, Asteraceae tannins [161] Trichodesma ISL-116018 ChotaKulfa Herb Leaves Juice Eye infections, Juice of leaves is taken with Steroids, 0.04 0.08 indicum (L.) Sm. dysentery addition of sugar and salt as per terpenoids, Boraginaceae taste to treat dysentery. lipids [162] Trifolium repens L. ISL 123169 Shatal Herb Flowers, Infusion Fevers and In case of leucchorea the infusion Flavonoids, 0.08 0.05 Fabaceae leaves, root leucorrhoea of flowers and leaves is taken. steroids [163] Valeriana jatamansi ISL 18643 Murma Herb Root Decoction Headache Decoction of 3-4 g of roots is Flavones, 0.03 0.14 Jones ex Roxb. consumed Glycosides [164] Caprifoliaceae in case of headache. Verbascum thapsus ISL 11315 Janglitambaku Herb Leaves Infusion Skin Boiled water is poured over the leaves Glycosides, 0.02 0.1 L. Scropulariaceae problems and kept for 2 h then taken orally for flavonoids, skin diseases and skin allergy. terpenoids [165] Verbena officinalis L. ISL 114005 Neelgu Herb Whole Decoction Joint pain Decoction is prepared and taken once Flavonoids, 0.06 0.14 (2018)14:16 Verbenceae plant a day for rheumatic disorders. Glucosides, Phenolics [166] Viola canescensWall. ISL 40466 Banafsha Herb Leaves Decoction Respiratory Leaves are boiled in water and taken Alkaloids, sterols, 0.04 0.15 Violaceae disorders orally for respiratory disorders. flavonoids [167] †Vitis vinifera L. ISL 59527 Daakh Climber Fruit Juice Cough, Fresh fruit juice is used directly in case Alkaloids, 0.04 0.14 Vitaceae asthma of cough. flavonoids, saponins, tannins [168] Zanthoxylum ISL 11640 Timber Shrub Seeds, bark Infusion Indigestion, Pour a cup of boiling water onto Anthraquinone, 0.04 0.15 armatum DC. hemorrhoids, 1–2 teaspoonful of the bark+ fruit glycoside Rutaceae ulcers and let infuse for 10–15 min and flavonoids used for stomach pain. [169] Ziziphus nummularia ISL 11625 Beri, Jand Shrub Root Infusion Diabetes Boil 5–8 g of grinded root with 1 glass Alkaloids, 0.1 0.1 (Burm.f.) Wight and of water till volume of water reduced to flavonoids, Arn. half. It is used to cure diabetes. phenolics [170] Rhamnaceae In column scientific name, species name starting with † indicates newly reported species. NH National Herbarium, UV use value, RFC relative frequency of citation. †† Uses in bold indicate preferred uses for a given plant ae1 f20 of 13 Page Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 14 of 20

Table 3 Relationship between uses of the 14 species with the highest UV and gender and age of informants: summary of the Poisson GLM (SE = standard error, − absent from the parsimonious model) Species UV Gender†: male Estimate SE p value Valeriana jatamansi Jones ex Roxb. 0.2196 − 0.881 0.381 0.021 Isodon rugosus (Wall. ex Benth.) Codd 0.0980 ––– Onopordum acanthium L. 0.0392 ––– Acacia nilotica (L.) Willd. ex Delile 0.0275 ––– Viola canescens Wall. 0.0275 ––– Rubus fruticosus auct. (L.) 0.0235 ––– Leucas cephalotes (Roth) Spreng. 0.0235 ––– Mentha arvensis L. 0.0235 ––– Achillea millefolium L. 0.0196 ––– Persicaria alpina (All.) H. Gross 0.0196 ––– Fagopyrum esculentum Moench 0.0196 ––– Solanum nigrum L. 0.0196 ––– Ziziphus nummularia (Burm.f.) Wight and Arn 0.0196 ––– Morus alba L. 0.0196 ––– †Female taken as reference

Age- and gender-related knowledge of plants used for HDs medicinal flora [34, 67] because the accumulation of me- Several informants’ socio-cultural and demographic dicinal plant knowledge is a life-long process [32]. Here, characteristics, in particular gender and age, are corre- we found no evidence for either quantitative or qualita- lated with plant knowledge [32, 33]. Such a relationship tive differences between men and women or between formally known as the age, gender, and dynamics of the two generations considered (< 40 years, ≥ 40 years). knowledge hypothesis [28] is specific to the type of The lack of difference between men and women was knowledge studied but is also context-specific [28]. also reported in the Sahelian zone of Africa [68] and Whereas some authors found that men are more may reflect the fact that both men and women are knowledgeable than women [45, 65], others found the equally involved in health-related issues not only at a contrary, especially where women served as the primary household level but also at a community level. However, healthcare providers in their families [34, 66]. Similarly, the lack of difference among generations may be because older people tend to have greater knowledge of the local HDs are common practices in the region and are

Table 4 Disease categories treated by herbal drinks Diseases Local names of diseases Relative frequency of citations (%) Gastrointestinal (GIT) diseases Aantoonkebemaryaan 17.43 Respiratory diseases Tanafsibemaryaaan 12.60 Fevers Bukhaar 9.92 Nail, skin, and hair disorders Jildi bemaryaan 8.58 Ear, nose, eye diseases Kann, naak,aankhkebemaryaan 8.04 Glandular disorders Ghadoodibemaryaan 7.51 Nervous disorders Aasabibemaryaan 6.97 Sexual diseases Jinsibemaryaan 6.97 Cardiovascular diseases Qalbibemaryaan 6.43 Muscle and skeletal disorders Pathoonkebemaryaan 6.17 Urinary disorders Faazlatibemaryaan 3.49 Oral diseases Moonhkebemaryaan 3.22 Infectious diseases Wabaiamraaz 2.68 Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 15 of 20

parts of the study area also reported recurrent practice of using medicinal plants against GIT ailments [38, 81]. Other conspicuous disorders cured by medicinal HDs include cardiovascular diseases, ear, nose, and eye dis- eases, glandular disorders, infectious diseases, muscle and skeletal disorders, nervous disorders, oral diseases, sexual diseases, and urinary disorders. The lowest cited ailments in this study were urinary disorders suggesting a weak prevalence of urinary problems in the study area. One of supporting reasons may be that people living in villages mostly use spring water or water from wells, which is clean from many impurities, so they have less Fig. 5 Informant consensus factor for diseases treated by herbal chance of developing kidney or urinary problems. A drinks in Azad Jammu and Kashmir number of disorders have been reported from the study area that are treated using medicinal HDs, and this accessible to everyone including youngers or because could be attributed to lack of health facilities in remote our sample did not include enough younger informants and high-altitude areas. to capture such a trend. (All informants were aged at In the present study, medicinal plants used as HDs were least 22 years, and only 17 informants were between 22 reviewed for the presence of different phytochemicals re- and 29 years). ported in previous literature (see Table 2, column “Active constituents”). Almost all the plants had been reported Treated disorders, plant part used, and forms of uses earlier for their one or more phytochemical compounds The people of Azad Jammu and Kashmir used HDs against indicating their significance in medicinal treatments. The 13 diseases. The finding that GIT diseases, respiratory dis- highest number of phytochemicals was reported for eases, and fevers were the most cited may suggest that Bauhinia variegata, Bergenia ciliata, Isodon rugosus, these disorders are the most frequent in the study area. Dif- Mentha arvensis, Oenothera rosea, Punica granatum,and ferent plant parts are used in treating various ailments de- Vitis vinifera. This information would be helpful in au- pending on the type and condition of ailment treated. thenticating the use of these species as herbal drugs in These plant parts are reported to accumulate a variety of curing various ailments and could be explored for their phytochemicals that are important for treatment of various detailed phytochemical, biological, and pharmacological disorders by local communities of people [69, 70]. Leaves aspects to facilitate the scientific community in new drug were found to be the most used plant part likely because discovery [82]. Flavonoids and alkaloids were reported in leaves are easy to collect as compared to other plant parts most of the HD species, indicating their significance. [71] but also because leaves possess chemical constituents Flavonoids have been reported for their significant effects in larger quantities, which may be responsible for against many ailments and disorders such as inflamma- medicinal properties [72]. This information is in accord- tion, allergy, and thrombic disorders [83]. The presence of ance with studies conducted in different regions of Pakistan alkaloids could be related to the indication of cytotoxic, [73, 74]. After leaves, roots, which are also known to pos- antibacterial, and analgesic properties in plants [84]. sess high concentrations of chemicals [75, 76], were the Pharmaceutical ethnobotanical studies are still very useful second most used plant part in this study. The main form for identifying novel or scarcely reported medicinal uses of preparation reported by informants was decoction. De- of plants, which could provide the foundation for new coctions are easier to prepare because plant parts are only drugs synthesis [85]. to be boiled with water [73]. Mostly, fresh plant parts are The values of ICF per disorder suggested that rela- preferably used in preparation of HDs. Informants reported tively few species were used for each ailment category, that drying the plant parts may cause their efficacy to de- with only one species, namely, Quercus oblonga, used crease because the ingredients present are damaged to for glandular disorders (disorders cited by 7.51% of in- some extent. Both modes of preparation and prescriptions formants) and only one other, namely, Tagetes minuta, are commonly used in traditional herbal medicine, and for eye diseases (disorders cited by 8.58% of informants). similar results have been presented in previous ethnobotan- Infectious diseases (ICF = 0.64) and oral diseases (ICF = ical records that were carried out in the study area [77–80]. 0.61) had the lowest ICF indicating a more diverse use The medicinal HDs reported in this study for treat- of plant species compared to other disease categories. ment of different diseases can also be exploited further Based on the utilitarian redundancy model, species shar- for their pharmacological and phytochemical properties. ing the same therapeutic function are redundant and are Previous ethno-botanical studies conducted in various predicted to experience a reduced use-impact because the Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 16 of 20

use pressure is diffused across a greater number of species revealed 17, i.e., 22%, new species used as HD species [86]. Thus, all things being equal, the loss or rarefaction of including Adiantum venustum D. Don, Euphorbia illirica one species in ailment categories with lower ICF is pre- Lam., Fagonia cretica L., Fagopyrum esculentum Moench, dicted to have little overall effect on the ethnomedicinal Gerbera gossypina Royle, Geum adnatum Wall., Isodon practices in the region [87]. On the contrary, particular rugosus (Wall. ex Benth.) Codd, Laphangium affine conservation attention should be paid to the single species (D.Don) Tzvelev, Leucas cephalotes (Roth) Spreng, Mueh- used for eye diseases and glandular disorders. lenbeckia hastulata (Sm.) I.M. Johnst., Onopordum acanthium L., Pimpinella diversifolia DC., Smilax aspera Most used species: medicinal uses and gender and L., Solanum surattense Burm. f., Solanum virginianum L., generation effects and Vitis vinifera L. This could be linked to the fact that The top five most used species for HDs were V. TM is a dynamic system and is based on a recurrent trial jatamansi, I. rugosus, O. acanthium, A. nilotica, and V. and error process that is transmitted across generations canescens. Their high UV may be due to their easy ac- and guides further use of plants [100, 101]. cessibility, availability, wide distribution in the area, and the strong ethnic culture to use these plants for medi- Implications for public health and environmental policies cinal purposes [88]. The medicinal and socio-economic From the results provided, GIT disorders (stomach re- importance of these species has been highlighted by lated health problems) and respiratory disorders (cough, many previous studies including ethno-pharmacology bronchitis) were the most prevalent health problems in prospections in the Himalayan region. V. jatamansi is a the study area. Stomach disorders probably spread in well-known medicinal species in Asia [89, 90]. The spe- these areas due to malnutrition and unhygienic use of cies is used in several Ayurvedic preparations and is food stuffs. Respiratory problems can be attributed to known to cure obesity, skin diseases, insanity, epilepsy, the high altitude of the study area, where the air is cold. and snake poisoning [91]. The essential oil and extract People traditionally use food medicines to treat such dis- of the species is used in the flavoring, pharmaceutical, eases, which in many cases are quite effective. Therefore, and fragrance industries, and about 30 products are the present findings suggest that public-health adminis- commercially available [91]. I. rugosus is extensively used trators should devise some health policies regarding the as TM for the management of various types of pain in- general health problems in the study area and the TM cluding tooth ache, gastric pain, abdominal pain, ear practiced by the indigenous community of the area as ache, and generalized body pain [92, 93]. O. acanthium part of their primary healthcare. has application in medical practice as a bactericide, car- diotonic, and hemostatic agent, is used against hypoton- icity [94, 95], and is a great bio-oil source [96]. O. Conclusion acanthium is sometimes sold as an ornamental plant Recently, the utilization of medicinal plants has gained and has reportedly been used to treat cancers and ulcers much attention due to their fewer side effects as herbal and to diminish discharges of mucous membranes [96]. remedies. The study area has a diversity of medicinal A. nilotica is a widespread multipurpose tree used ex- plants, which are still used against many ailments, but tensively for the treatment of various diseases, e.g., colds, there is lack of traditional knowledge transfer among the bronchitis, diarrhea, dysentery, biliousness, bleeding new generation. From ancient times, the use of hot piles, and leukoderma [97], and its bioactivity has been watery infusions made from wild or cultivated plants proven by many studies [94, 98]. V. canescens is com- have been employed as a remedy for a number of ail- monly used as TM in the north-west Himalaya for the ments. In present study, 72 medicinal plants used as treatment of protozoan infections and fever including HDs (decoction, infusion, tea, juices) for curing various malaria [21], and its anti-malarial activity was proven by ailments were documented. The most preferred form of Verma, Dua [99]. utilization was decoction, and herbs were the dominant A significant relationship of the UV with gender was life form exploited. Leaves were used mostly in prepar- found for only 1 species out of the top 14 most used ation of medicinal HDs. The key informants were mostly species, namely, for V. jatamansi. This finding corrobo- male between 40 and 50 years old, and some herbalists rates the hypothesis that the effect of gender and age also provided the required information. The wealth of category on the medicinal uses of plant species is original knowledge obtained from the present work species-specific and context-specific [28]. strengthens the significance of expanding the study to other parts of the study area. The therapeutic uses of the Novelty and added value for the study region HDs provided basic data for further research focused on The comparison of species reported in the present study phytochemical and pharmacological studies and conser- with those in previous literature of the same region vation of the most important species. Rashid et al. Journal of Ethnobiology and Ethnomedicine (2018) 14:16 Page 17 of 20

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